16 December 2012

Madness, Deinstitutionalization & Murder

By Clayton Cramer

For those of us who came of age in the 1970s, one of the most
shocking aspects of the last three decades was the rise of mass public
shootings: people who went into public places and murdered complete
strangers. Such crimes had taken place before, such as the Texas Tower
murders by Charles Whitman in 1966,1 but their rarity meant that they were shocking.

Something changed in the 1980s: these senseless mass murders started
to happen with increasing frequency. People were shocked when James
Huberty killed twenty-one strangers in a McDonald’s in San Ysidro,
California in 1984, and Patrick Purdy murdered five children in a
Stockton, California schoolyard in 1989. Now, these crimes have become
background noise, unless they involve an extraordinarily high body count
(such as at Virginia Tech) or a prominent victim (such as Rep.
Gabrielle Giffords). Why did these crimes go from extraordinarily rare
to commonplace?

For a while, it was fashionable to blame gun availability for this dramatic increase. But guns did not become
more available before or during this change. Instead, federal law and
many state laws became more restrictive on purchase and possession of
firearms, sometimes in response to such crimes.2 Nor has the nature of the weapons available to Americans changed all that much. In 1965, Popular Science announced that Colt was selling the AR-15, a semiautomatic version of the M-16 for the civilian market.3
The Browning Hi-Power, a 9mm semiautomatic pistol with a thirteen-round
magazine, was offered for sale in the United States starting in 1954,4 and advertised for civilians in both the U.S. and Canada at least as early as 1960.5 If gun availability does not explain the increase of mass public murders, what else might?

At least half of these mass murderers (as well as many other
murderers) have histories of mental illness. Many have already come to
the attention of the criminal justice or mental health systems before
they become headlines. In the early 1980s, there were about two million
chronically mentally ill people in the United States, with 93 percent
living outside mental hospitals. The largest diagnosis for the
chronically mentally ill is schizophrenia, which afflicts about 1
percent of the population, or about 1.5 percent of adult Americans.6 A 1991 estimate was that schizophrenia costs the United States about $65 billion annually in direct and indirect costs.7

The $19 billion in direct costs (as of 1991) included the criminal
justice system dealing with a few spectacular and terrifying crimes
(such as mass public shootings), and millions of infractions, arrests,
and short periods of observation.8 A 1999 study found that
16.2 percent of state prison inmates, 7.4 percent of federal prison
inmates, and 16.3 percent of jail inmates, were mentally ill.9 As of 2002, about 13 percent of mentally ill state prison inmates nationwide had been convicted of murder.10
A detailed examination of Indiana murder convicts found that 18 percent
were diagnosed with “schizophrenia or other psychotic disorder, major
depression, mania, or bipolar disorder.”11

In the 1960s, the United States embarked on an innovative approach to
caring for its mentally ill: deinstitutionalization. The intentions
were quite humane: move patients from long-term commitment in state
mental hospitals into community-based mental health treatment. Contrary
to popular perception, California Governor Ronald Reagan’s signing of
the Lanterman-Petris-Short Act of 196712 was only one small part of a broad-based movement, starting in the late 1950s.13
The Kennedy Administration optimistically described how the days of
long-term treatment were now past; newly-developed drugs such as
chlorpromazine meant that two-thirds of the mentally ill “could be
treated and released within 6 months.”14

At about the same time, two different ideas came to the forefront of American progressive thinking: that there was a right to mental health treatment, and a right
to a more substantive form of due process for those who were to be
committed to a mental hospital. If there was a right to mental health
treatment, then judges could use the threat of releasing patients as a
way to force reluctant legislatures to increase funding for treatment.15

The notion of due process for the mentally ill was not radical.
American courts have been wrestling with this question from the 1840s
onward.16 While perhaps not up to the exacting standards of
the American Civil Liberties Union, by the end of the nineteenth
century, there was something recognizably like due process before the
mentally ill were committed.17 What changed in the 1960s was
the result of ACLU attorneys such as Bruce J. Ennis, who claimed that
less than 5 percent of mental hospital patients “are dangerous to
themselves or to others” and that the rest were improperly locked up
“because they are useless, unproductive, ‘odd,’ or ‘different.’”18

Until the 1960s, courts used a medical model when considering commitment: the government’s actions were part of “the historic parens patriae
power, including the duty to protect ‘persons under legal disabilities
to act for themselves.’ . . . The classic example of this role is when a
State undertakes to act as ‘the general guardian of all infants,
idiots, and lunatics.’”19 Instead, public safety alone became
the legitimate basis for commitment, and with it, a more exacting
standard, a bit less than is required for convicting criminal
defendants.20

Neither a right to treatment nor a more demanding application of due
process alone was particularly destructive, but in combination they made
hundreds of thousands of seriously mentally ill people homeless,21 where many died of exposure22 and violence.23
They fell through the cracks, living shorter, more miserable lives, and
often greatly degrading the quality of urban life for everyone else.24
A fraction became something quite a bit more unsettling than the
mentally ill person begging on the street or disrupting the public
library: they became the mad mass murderers of the modern age.

John Linley Frazier was one of the first such examples. Like many
other schizophrenics, he first exhibited symptoms in his early 20s.
Fixated on ecology, after a traffic accident he became convinced that
God had given him a mission to rid the Earth of those who were altering
the natural environment. Frazier’s mother and wife recognized how
seriously ill he was, and tried to obtain treatment for him, but he
refused it.

In October of 1970, Frazier warned them that “some materialists might
have to die” in the coming ecological revolution. The following Monday,
Frazier murdered “Dr. Victor M. Ohta, his wife, their two young sons,
and the doctor’s secretary.”25 He blindfolded them, tied them
up, shot each of them, and threw them into the pool. Then he burned the
house to return it back to the environment. Frazier’s bizarre behavior
and statements soon led to his arrest. He was found legally sane,
convicted, and sentenced to life in prison.26 (The legal
definition of insane is considerably narrower than the psychiatric
definition of insane; it also seems that juries sometimes convict even
clearly insane defendants, out of fear that they might be released after
being declared “cured.”)

Patrick Purdy, a mentally ill drifter, used his Social Security
Disability payments to buy guns, while having a series of run-ins with
the law. After one suicide attempt in jail in 1987, a mental health
evaluation concluded that he was “a danger to his health and others.”27
In January 1989, Purdy went onto a schoolyard in Stockton, California
with an AK-47 rifle, murdered five children and wounded twenty-nine
others, before taking his own life.28

Federal prosecutors held back for a few days from indicting Laurie
Wasserman Dann in May 1988 for a series of harassing and frightening
phone calls—and in those few days, she went on a rampage, killing one
child in an elementary school, wounding five children and one adult, and
distributing poisoned cookies and drinks to fraternities at
Northwestern University. She had a history of odd behavior going back at
least two years, riding the elevator in her apartment building for
hours on end.29

Buford Furrow was a member of a neo-Nazi group in Washington State.
Conflicts with his wife led her to take him to a mental hospital, where
he threatened suicide and “shooting people at a nearby shopping mall.”
He threatened nurses with a knife. At trial, he told the judge about his
mental illness problems and suicidal/homicidal fantasies. The judge
refused to hospitalize Furrow, sending him to jail instead. Released
within a few months, Furrow went to Los Angeles in August 1999, where he
acted out the fantasy that he had earlier told the court: he shot up a
Jewish community center, wounding five people, and murdering an
Asian-American mail carrier nearby.30

Larry Gene Ashbrook was another killer who gave plenty of warning,
writing letters to local papers referring “to encounters with the CIA,
psychological warfare, assaults by co-workers and being drugged by
police.” Neighbors had long noticed his bizarre behavior—exposing
himself in response to laughter that he thought (incorrectly) was
directed at him. In September 1999, he went into a Fort Worth, Texas
Baptist Church. He screamed insults about their religion, then killed
seven people inside, before killing himself.31

In April 2007, David W. Logsdon of Kansas City, Missouri beat to
death a neighbor, Patricia Ann Reed, and stole her late husband’s rifle.
At the Ward Parkway Center Mall, he shot and killed two people at
random, wounding four others.32 Only the fortuitous arrival of police, who shot Logsdon to death, prevented a larger massacre.

According to Logsdon’s sister, Logsdon had a history of mental
illness and alcoholism. His family contacted police over Logsdon’s
deteriorating mental condition and physical conditions in Logsdon’s
home. The police took Logsdon to a mental hospital for treatment in
October 2005, concerned that he was suicidal. He was released six hours
later with a voucher for a cab and a list of resources to contact.

In this case, the problem was not that the law prevented Logsdon from
being held. Instead, Logsdon’s early release was because of a shortage
of beds in Missouri public mental hospitals. In addition, Missouri in
2003 had eliminated mental health coordinator positions in its community
mental health centers as a cost-cutting measure.33

After Russell Eugene Weston Jr. shot two police officers at the U.S.
Capitol in 1999, he explained to the court-appointed psychiatrist that
he needed to do it because “Black Heva,” the “most deadliest disease
known to mankind,” was being spread by cannibals feeding on rotting
corpses. He needed to get into the Capitol “to gain access to what he
called ‘the ruby satellite,’ a device he said was kept in a Senate
safe.” Weston explained that the two “cannibals” he had shot to death,
police officers “Jacob J. Chestnut and John M. Gibson,” were “not
permanently deceased.” Weston explained that he needed access to the
satellite controller so that he could turn back time.

Before this incident, Weston had been involuntarily hospitalized for
fifty-three days in Montana after threatening a neighbor, but he was
then released. According to Weston’s parents, he had been losing the
battle with schizophrenia for two decades before he went to the Capitol.34

An employee of the Postal Service, Jennifer Sanmarco was removed from
her Goleta, California workplace in 2003 because she was acting
strangely, and placed on psychological disability. She moved to Milan,
New Mexico, where her neighbors described her as “crazy as a loon.” “A
Milan businessman said he sometimes had to pick her up and bring her
inside from the cold because she would kneel down and pray, as if in a
trance, for hours.” She returned to the Goleta mail sorting facility in
January 2006—and murdered five employees, before taking her own life.35

When I was first writing these paragraphs in April 2007, America was
mourning a tragedy at Virginia Tech, where Cho Seung-Hui murdered
thirty-two students and faculty before taking his own life. His
psychological problems had been evident for some months before, and he
was briefly hospitalized after a stalking incident. The special judge
appointed to determine whether Seung-Hui should be involuntarily
committed concluded that he was a danger to himself—but allowed
Seung-Hui to commit himself. The next day, Seung-Hui left the hospital,
and soon he was back on campus, living in a world of paranoid
schizophrenia, culminating in the largest gun mass murder in U.S.
history.36

Many other spectacularly horrifying crimes followed that one. Jiverly
Wong murdered thirteen people before killing himself at a Binghamton,
New York immigrant-assistance center in April 2009. Letters by Wong to
local news media demonstrate what “Dr. Vatsal Thakkar, assistant
professor of psychiatry at NYU’s Langone Medical Center” described as
“major mental illness, quite possibly paranoid schizophrenia.”37

Rep. Gabrielle Giffords was one of many people shot at a town hall
meeting in Tucson in January 2011. The alleged shooter, Jared Lee
Loughner, had a history of police contacts involving death threats, and
was expelled from college for bizarre actions that clearly established
that he was mentally ill. A series of disturbing web postings and
YouTube videos also confirmed that Loughner’s grasp on reality was
severely impaired.38 Court-ordered psychiatric evaluations
concluded that Loughner was suffering from schizophrenia, and was
incompetent to stand trial.39

Nor were these problems specific to the United States and its “gun
culture” as some contend. Other nations which started down the same road
toward deinstitutionalization a few years after the United States have
suffered many similar mass murders.

In eastern France, Christian Dornier, thirty-one, under treatment for
“nervous depression,” murdered fourteen people in three villages.40 He was later found not guilty by reason of insanity.41
Eric Borel, sixteen, murdered his family with a hammer and a baseball
bat, then went on a shooting rampage in the nearby town of Cuers, France
in September 1995. He killed twelve people besides himself.42
In March 2002, Richard Durn murdered eight local city officials and
wounded nineteen others in Nanterre, a suburb of Paris. Durn had a
master’s degree in political science and “a long history of
psychological problems.” He was chronically unemployed. After his
arrest, he was described as “calm but largely incoherent,” but then
leaped to his death through a window.43

In April 2002, nineteen-year old Robert Steinhaeuser went into a
school from which he had been expelled in Erfurt, Germany and murdered
eighteen people before killing himself.44 In April 2011,
Wellington Menezes de Oliveira went into a school in Rio De Janeiro,
Brazil, murdering twelve children, before killing himself. His suicide
note was unclear, but a police officer described de Oliveira as a
“hallucinating person.”45 Later the same month, Tristan van
der Vlis went into a shopping mall in Alphen aan der Rijn, the
Netherlands, and shot six people to death. In spite of very strict Dutch
gun licensing laws, and van der Vlis’s history of mental illness
hospitalization and suicide attempts, he had a gun license.46

Along with the spectacular cases of public mass murder, there were
many minor tragedies involving one-on-one murders, soon forgotten
outside the family and friends of their victims. In 1983, the
seventeen-year-old daughter of my landlord was murdered in San
Francisco’s Golden Gate Park. The killer had a long history of mental
problems, some of which had sent him to prison, but none of which had
caused hospitalization. As so often happens, this tragedy led to
another. The continuing legal battles over the killer’s sanity soon led
the murder victim’s grief-stricken father to sneak a gun into the
courtroom, and open fire.47

Edmund Emil Kemper III was a sexual sadist who killed his paternal
grandparents at age fifteen, in an attempt to punish his mother.
California hospitalized him until he was twenty-one, and then released
him on parole in 1969. Over a bit less than a year, starting in May
1972, Kemper shot, stabbed, and strangled eight women, including his
mother. (The rest of what he did is too horrifying to describe.) He
repeatedly called the police to persuade them that he was the killer.
Eventually, he was arrested, found legally sane, convicted, and
sentenced to life in prison.48

Herbert William Mullin was another schizophrenic whose illness
arrived just as California was deinstitutionalizing its mental patients.
Until 1969, just before Mullin’s 22nd birthday, it was not obvious that
he was mentally ill. Mullin was persuaded to voluntarily enter
Mendocino State Hospital, on California’s north coast on March 30. Six
weeks later, having refused to participate in treatment programs—and
under no legal obligation to remain—he left.

Mullin had trouble holding jobs, because he was “hearing voices,”
which understandably frightened employers. Over several months, he was
in and out of mental hospitals in California and Hawaii for brief
periods, sometimes voluntarily, sometimes not. On his return to
California, his behavior so scared his parents that within thirty miles
of the airport, his parents stopped to call the Mountain View Police
Department. Mullin was again hospitalized against his will at Santa Cruz
General Hospital for a few weeks, and was again discharged, “less noisy
and belligerent”—but not well.

Mullin’s parents tried to find long-term hospitalization for their
son, who was clearly dangerous to others. But California’s hospitals
were busily emptying out; they were not looking to take new patients. In
light of Mullin’s history of voluntarily entering, then leaving mental
hospitals, it might not have mattered, without an involuntary
commitment.

In four months of late 1972 and early 1973, Mullin murdered thirteen
people in the Santa Cruz area. Why? Mullin believed that murder
prevented the San Andreas Fault from rupturing. Mullin was found legally
sane and guilty of ten murders.49

While most of these murders involved guns, there were many others
that did not. Some are often completely unknown outside the community
where they happened because the body count was low. In Rohnert Park,
California, a thirty-three-year-old paranoid schizophrenic named Hoyt
was arrested outside his mother’s home, holding a sword. Inside, his
mother lay dying of sword wounds. A relative described the problem: the
mental health system can do nothing until a mental patient “becomes a
threat to himself or others.” Hoyt had stopped taking his medication,
and there was nothing that could be done: “‘He’s over 18, he can’t be
forced to stay on his medications until something happens. . . . Well,
something has happened.’”50

In May 1998, San Francisco put twenty-one-year-old Joshua Rudiger on
probation and ordered him to enter a live-in treatment center in San
Francisco after shooting a former friend with a bow and arrow.
Authorities knew that Rudiger was mentally ill; he had been confined to
Atascadero State Hospital for six months, diagnosed as suffering from
schizophrenia and bipolar disorder—and then declared cured, and able to
stand trial for the bow and arrow incident.

Rudiger never showed up at the treatment center, nor did anyone go
looking for him. In one of the more disturbing understatements of the
day, Carmen Bushe, the head of community services for San Francisco’s
Probation Department observed, “It’s perhaps not necessarily a cohesive
system.” When Rudiger next came to the attention of police, it was for
slashing the throats of four homeless people, killing one, and drinking
the blood of the others.51 When arrested, Rudiger told police
that he was a 2600-year-old vampire. Yet the jury concluded that he was
legally sane, because he knew what he was doing, and he knew it was
wrong. Rudiger was sentenced to twenty-three years to life.

Rudiger’s mental problems started at age four.52 But
others were people who made it to adulthood before mental illness
appeared. Richard Baumhammers was an immigration attorney—and yet
something went wrong sometime in his 20s, when he became convinced that
someone had poisoned him on a trip to Europe. He “had been treated since
1993 for mental illness and had voluntarily admitted himself to a
psychiatric ward at least once . . . .” When the final break happened,
he killed five people.53 A jury found him legally sane, and convicted him of first-degree murder. The court sentenced Baumhammers to death.54

In 1986, Juan Gonzalez was arrested for shouting threats on the
street, “I’m going to kill! God told me so!” Doctors diagnosed him with a
“psychotic paranoid disorder,” gave him some antipsychotic medicines to
take, made an appointment for outpatient treatment, and released him
after two days. Within a few days he went on a rampage on the Staten
Island Ferry with a sword, killing two people, and wounding nine. If not
for the presence of a retired police officer who disarmed Gonzalez at
gunpoint, the death toll might have been much higher.55

Gonzalez was finally considered too dangerous to release, and the
courts ordered his involuntary commitment to a mental hospital. He
repeatedly contested his commitment. In March 2000, the courts granted
Gonzalez unsupervised leave from the hospital, with a number of
conditions on his actions for five years.56

When The New York Times did a detailed study of 100 U.S. rampage killers in 2000, they pointed out that there was often plenty of warning:

Most of them left a road map of red
flags, spending months plotting their attacks and accumulating weapons,
talking openly of their plans for bloodshed. Many showed signs of
serious mental health problems.

. . .

The Times’ study found that many of the
rampage killers… suffered from severe psychosis, were known by people in
their circles as being noticeably ill and needing help, and received
insufficient or inconsistent treatment from a mental health system that
seemed incapable of helping these especially intractable patients. . . .

The Times found what it called “an extremely high
association between violence and mental illness.” Of the 100 rampage
murderers, forty-seven “had a history of mental health problems” before
committing murder, twenty had been previously hospitalized for mental
illness, and forty-two had been previously seen by professionals for
their mental illness. While acknowledging that mental illness diagnoses
“are often difficult to pin down . . . 23 killers showed signs of
serious depression before the killings, and 49 expressed paranoid
ideas.”57

There is no shortage of these tragedies that have one common element:
a person whose exceedingly odd behavior, sometimes combined with minor
criminal acts, would likely have led to confinement in a mental hospital
in 1960. After deinstitutionalization, these people remained at large
until they killed. The criminal justice system then took them out of
circulation (if they did not commit suicide), but this was too late for
their victims.

There is a clear statistical relationship between
deinstitutionalization and murder rates. Violent crime rates rose
dramatically in the 1960s, most worrisomely in the murder rate.58

One explanation for this doubling of murder rates from 1957 to 1980
is that the Baby Boomers (the children born in the ten years after World
War II) were reaching their peak violent crime years of adolescence.
Some conservatives blamed the civil liberties revolution of the Warren
Court for rendering the criminal justice system impotent to deal with
crime, and the expansion of drug abuse by the Flower Power generation of
the 1960s. This fails to answer what caused the decline in violent
crime—and specifically murder—in the 1990s. This was variously ascribed
to the Baby Boom Echo generation passing out of its peak violent crime
years, and to increasingly tough sentencing for violent crimes.

According to Professor Bernard E. Harcourt, sociologists examining
the expansion of imprisonment in the 1990s—the so-called “incarceration
revolution”—missed the even more important component of
institutionalization: mental hospitals. When adding mental hospital
inmates to prisoners, there is an astonishingly strong negative
correlation between the institutionalization rate, and the murder rate:
“The correlation between the aggregated institutionalization and
homicide rates is remarkably high: -0.78.” Harcourt found that even when
adjusting for changes in unemployment and the changing fraction of the
population that was at their peak violent crime ages, the negative
correlation remained strong—and did a better job of predicting both the
1960s rise and the 1990s decline in murder rates than other models.59
Similar results appear when using state level data for
institutionalization and murder rates, and controlling for more
variables.60

It is easy to see why the deinstitutionalization of the mentally ill
would cause a rise in violent crime rates, including murder. When
Massachusetts opened Worcester Hospital in the early nineteenth century,
the law limited its admissions to “the violent and furious.” Dr. Samuel
B. Woodward, the hospital’s first superintendent, noted that “More than
half of those manifesting monomania and melancholia [roughly equivalent
to paranoid schizophrenia and psychotic bipolar disorder in modern
terms] are said to exhibit a propensity to homicide or suicide.”61
The opening of state asylums in Vermont in 1836 and New Hampshire in
1840 “contributed to the decline in . . . spouse and family murders
during the 1850s and 1860s.”62 Accounts of mass murder
(usually involving families killed by mentally ill members) appear often
enough in this period to understand why concerns about insanity could
lead to hospitalization.63

Curiously, during the period before deinstitutionalization, the mentally ill seem to have been less likely
to be arrested for serious crimes than the general population. Studies
in New York and Connecticut from the 1920s through the 1940s showed a
much lower arrest rate for the mentally ill.64 In an era when
involuntary commitment was relatively easy, those who were considered a
danger to themselves or others would be hospitalized at the first signs
of serious mental illness. The connection between insanity and crime
was apparent,65 and the society took a precautionary
approach. Mentally ill persons who were not hospitalized were those not
considered a danger to others. This changed as deinstitutionalization
took effect.

As early as 1976, studies of deinstitutionalized New York City mental
patients showed that they had disproportionate arrest rates for rape,
burglary, and aggravated assault.66 A study of San Mateo
County, California mental hospital patients also showed disproportionate
arrest rates for murder, rape, robbery, aggravated assault, and
burglary: for murder, 55 times more likely to be arrested in 1973, and
82.5 times more likely in 1972. Mental patients were about nine times
more likely to be arrested for rape, robbery, aggravated assault, and
burglary than the general population of the county.67 Even
patients with no pre-hospitalization arrests were five times as likely
to be arrested for violent crimes as the general population.68 Studies in Denmark and Sweden similarly show that psychotics are disproportionately violent offenders.69 Recent surveys in the United States also show that “violence and violent victimization are morecommon among persons with severe mental illness than in thegeneral population.”70

One recent study arguing otherwise suggests that mental illness alone
is not the cause, but one of several risk factors that in combination
increase violence rates. Mental illness and substance abuse seem to be
an especially dangerous combination.71 It is important to
remember that even though the mentally ill are a disproportionately
violent population, most of this population is primarily a threat to
themselves.72

Deinstitutionalization created a revolving door, in which those who
committed minor crimes might be briefly held for observation, but were
then again released to the community. Once a mentally ill offender ends
up in the criminal justice system for the most serious crimes, such as
murder or rape, sympathy for their mental illness declines quite
dramatically. As some of the examples given above demonstrate, juries
and judges often find people who were clearly mentally ill to be legally
sane.

Deinstitutionalization played a substantial role in the dramatic
increase in violent crime rates in America in the 1970s and 1980s.
People who might have been hospitalized in 1950 or 1960 when they first
exhibited evidence of serious mental illness today remain at large until
they commit a serious felony. The criminal justice system then usually
sends these mentally ill offenders to prison, not a mental hospital.

The result is a system that is bad for the mentally ill: prisons, in
spite of their best efforts, are still primarily institutions of
punishment, and are inferior places to treat the mentally ill. It is a
bad system for felons without mental illness problems, who are sharing
facilities with the mentally ill, and are understandably afraid of their
unpredictability. It is a bad system for the victims of those mentally
ill felons, because in 1960, a mentally ill person was much more likely
to have been hospitalized before victimizing someone else. It is a bad
system for the taxpayers, who foot the bill for expensive trials and
long prison sentences for the headline tragedies, and hundreds of
thousands of minor offenses, instead of the much less expensive
commitment procedures and perhaps shorter terms of treatment.

Deinstitutionalization of the mentally ill was one of the truly
remarkable public policy decisions of the 1960s and 1970s, and yet its
full impact is barely recognized by most of the public. Partly this was
because the changes did not happen overnight, but took place
state-by-state over two decades, with no single national event. While
homelessness received enormous public attention in the early 1980s, the
news media’s reluctance to acknowledge the role that
deinstitutionalization played in this human tragedy meant that the
public safety connection was generally invisible to the general public.
The solution remains unclear, but recognizing the consequences of
deinstitutionalization is the first step.

* Adjunct Faculty, College of Western Idaho. Cramer’s work has
been cited in Justice Scalia’s opinion in District of Columbia v.
Heller, 128 S. Ct. 2783, 2795 (2008), in Justice Alito’s opinion in
McDonald v. Chicago, 130 S. Ct. 3020, 3040 n.21, 3041 n.25, 3043, and
Justice Breyer’s dissent in McDonald v. Chicago, 130 S. Ct. 3020, 3132.
This paper is adapted from a yet-to-be-published book, MY BROTHER RON: A
PERSONAL AND SOCIAL HISTORY OF THE DEINSTITUTIONALIZATION OF THE
MENTALLY ILL. Cramer’s website is http://www.claytoncramer.com.

Endnotes

1 See generally Gary M. Lavergne, A Sniper in the Tower: The Charles Whitman Murders (1997).

14 Message from the President of the United States Relative to Mental Illness and Mental Retardation, Feb. 5, 1963, reprinted in Henry A. Foley & Steven S. Sharfstein, Madness and Government: Who Cares for the Mentally Ill? 166-7(1983), quoted in Rael Jean Isaac & Virginia C. Armat, Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill77-78 (1990).

15 Morton Birnbaum, The Right to Treatment, 46 A.B.A. J.499 (May 1960); David L. Bazelon, The Right to Treatment: The Court’s Role, 20 Hosp. & Community Psychiatry 129-130 (May 1969).

60 Bernard E. Harcourt, From the Asylum to the Prison: Rethinking the Incarceration Revolution—Part II: State Level Analysis (University of Chicago Law & Economics, Olin Working Paper No. 335, Public Law Working Paper No. 155, March 2007), available athttp://ssrn.com/abstract=970341.

63 See, e.g., Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812, at291-306
(1991); James W. North, The History of Augusta, from the Earliest
Settlement to the Present Time… 208-14 (1870); Steven Mintz, Moralists
and Modernizers: America’s Pre-Civil War Reformers 6(1995);
Royal Ralph Hinman, A Catalogue of the Names of the Early Puritan
Settlers of the Colony of Connecticut… 165-7 (1852); George Simon
Roberts, Historic Towns of the Connecticut River Valley153-6 (1906).